Provider Demographics
NPI:1457636987
Name:ASIRVADAM, ALEXANDRA MONIKA (LPC, LCDC)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:MONIKA
Last Name:ASIRVADAM
Suffix:
Gender:F
Credentials:LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8830 MATTIE LN
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75167-7282
Mailing Address - Country:US
Mailing Address - Phone:214-733-4747
Mailing Address - Fax:972-617-7656
Practice Address - Street 1:300 N IH 35 E
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-5226
Practice Address - Country:US
Practice Address - Phone:214-733-4747
Practice Address - Fax:972-617-7656
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-16
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64198101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2848400-01Medicaid